Yearly Archives: 1995

THE FOURTH WORLD Conference on Women held in Beijing in September was like the proverbial elephant and the blind men. The reactions it evoked were conditioned by the perception of each observer. It was billed as the “largest gathering ever for a UN conference on women” by Newsweek and a gathering of women who “suddenly loom as a great force” by Betty Friedan, the author of Feminine Mystique and the founder of the American feminist movement in the sixties. Continue reading Spirit of Sisterhood→

This book, recently published by the London-based Panos Institute,should be of special interest in the context of the grim crisis which has gripped Karachi for the last several months.

Arms to Fight Arms to Protect: Women Speak out about Conflict records the testimonies of 200 women from 12 countries who have been affected by war in one way or another.

The conflict in Karachi might not have escalated to the scale of the aimed confrontation in Bosnia, Lebanon, Somaliland, Sri Lanka, Liberia, Uganda, Tigray, Nicaragua and El Salvador (some of the countries where the studies were carried out) yet. But the firsthand accounts of the women who have been victims of war should serve as a warning to those who control the destiny of this strifetorn metropolis in Pakistan.

It emerges clearly from the harrowing tales of women who have been active participants in the .armed struggle or silent victims of the violence perpetrated by power-. hungry men that recourse to force does’ not always pay. Wadad, a Lebanese woman whose husband was kidnapped, says, “the damage is done, what’s happened to the country (in terms of) victims and ruins and twisting of minds. But the more dangerous thing that I fear is that we are building for a new war.”

Others fear that their sacrifices have been in vain. Sabaah from Somaliland speaks of another war that was inflicted on the widows of the first war.

Significantly, quite a number of the women interviewed by Panos did not show any involvement in the decision to go to war. Some like the women from Uganda perceived the war to be a struggle between power-hungry men wanting to get rich by force. Even where the women identified with their men because of ethnic or ideological factors they were not generally a party to the decision-making which led to the conflict. But that does not imply that all women are peace-loving and do not take up arms. They, • however, by virtue of their roles as carers and mothers in the home and organisers of peace and rehabilitation in society are less inclined to take up arms.

Rarely have conflicts led to the liberation of women. On the contrary, the repercussions of war on women have been traumatic. They have been more vulnerable especially when rape is used as a weapon of war to demoralise one side. In many cases, the agony oft women has intensified after the** war has ended. They have had to bear the ‘brunt of surviving in a shattered economy and, destabilised and fragmented society.

Marie of Lebanon put it suecinctly when she said, “War is what happens afterwards.” The task of rehabilitation and reconstruction” is after all not an easy one, especislly when women continue to be the victims of social prejudices and discrimination.

Panos has done an excellent job in putting this book together. For the women who participated in the project the process of sharing their experience and recalling their past was a valuable exercise to ease the*- pain many of them continue to feel years after the war has ended as in Vietnam and when the fighting still continues as in the Balkans. For the readers the book is important to help them understand and learn from the experience of others. If this book can preempt even one conflict, it would have served a use-‘ ful purpose.

THE TRAUMATISED citizens of Karachi, where violence has killed over 1900 people in 18 months, live with a dilemma. Should they seek the help of the police in an emergency?

The harrowing experiences people recount of the law enforcers’ highhandedness deter victims of crime from seeking redress. Only in serious cases involving murder, kidnapping and car snatching are reports lodged, when one cannot avoid dealing with the custodians of the law.

The failure of the police to curb crime and violence in Karachi in a way vindicates the skepticism of the public. The credibility of the police is low and rampant corruption has robbed them of the confidence of the people. But the situation need not be all that bleak. Crime and violence need not be the curse of Karachi, if only the political will and the necessary systems are created to make the city safe and secure.

This can be done, as has been convincingly proved by Jameel Yusuf, who co-founded with Nazim Haji the Citizens-Police Liaison Committee in 1990 when kidnapping for ransom had become a lucrative occupation in Karachi Since most of the victims were businessmen who were targeted because of their wealth, it was not surprising that two of their most dynamic members should have decided to act. That saw the birth of the CPLC, of course with the government’s blessings. Governor Fakhruddin Ebrahim gave the Committee space in the Governor’s House compound to set up its Central Reporting Cell with all its electronic adgetry and computers. Within five years, the CPLC had proved that the most hopeless of situations can be changed. The incidence of kidnapping for ransom fell from 79 in 1990 to three this year because the Committee’s success in solving a high number of cases has proved to be a deterrent.More important than that was the fact that for the first time a new avenue was now available to the harassed citizens to seek prompt redress when they became victims of police excesses. The CPLC has emerged as an arbiter to look into the citizens’ complaints against the police.

Given his excellent track record, Jameel Yusuf’s observations carry a lot of weight. But he knows his limits. He will not try to bend the law and operates within the existing legal framework — though he does feel that many laws need changing and it is time our lawmakers did something about it. He is also very categorical about the nature of the present violence in Karachi: it has political roots and should therefore be resolved at the political level. Hence the dialogue between the government and the MQM is a positive development,
though the good offices of a mediator could have helped reconcile the differences between the two sides
faster. After all, the disagreements are quite basic. The person who is seen as a terrorist by one side is a freedom fighter for the other.

Moreover, the crisis in Karachi also has a social dimension for which the CPLC chief blames the
government — in fact all governments which have been in power. They have neglected this metropolis wilfully while fleecing it to the maximum. “If you cannot provide people the basic civic amenities which are their due such as water, sanitation and electricity and they are denied their fundamental rights of schooling for their children and jobs for their youth, how can you expect the citizens not to get disgruntled. That is how some elements have been able to exploit the deprivation and discontent of the people of Karachi for their political ends,” Jameel notes philosophically. They train the teenagers to use the gun and promise to give the people what others have failed to provide in 48 years.

But even with the best of political governance, crime cannot be eradicated totally. In fact, it has been growing worldwide with the growth in population and the development of technology. This needs to be combated with the help of an efficient police force. Do we have such a force?

Jameel Yusuf has specific ideas about the role of the police. He has studied and worked with the Karachi police very closely — that is what the CPLC has been doing in the last five years — and has managed to make inroads into some vital areas of crime detection.

He admits that to a great extent the police is corrupt and inept. But for that he blames the government and the administration. No effort has been made to recruit the right people for the job. Every government which comes into office doles out political favours by getting its supporters appointed to the force. With a stroke of the pen, a political leader has hundreds of men with unknown antecedents recruited in the police. The home addresses they supply are fake. Their characters have not been verified and their records are not available. Yet they have been trained and provided arms ostensibly to fight crime.”Now you have the unenviable situation where you are required to fight the terrorism let loose by many of the same people you yourself have trained and armed. The poor civilians who are not responsible for this state of affairs have become innocent victims,” Jameel observes.

What is needed is a major change in the mode of recruitment to the force. Recruitment needs to
be conducted professionally. Why is it that no one questions the discipline in the armed forces? There is
a chain of command there, and there are rigorous procedures and qualifications for recruitment. Besides, no one can jump ranks or outsiders brought in to infiltrate it. Why are policemen appointed without proper testing? Why are many of them inducted in midstream overriding someone who should have been senior? They are not even required to have passed their Intermediate exam and that is why their expertise is so low.
Jameel Yusuf very strongly recommends that an independent commission be set up to recruit the police. Without some set standards on the basis of which the policemen are selected, the force can never act as a truly professional body. Jameel Yusuf is also critical of the fact that every government in power has sought to use the police for its pojitical ends. This has corrupted the police more than anything else and robbed it of its credibility.

Another factor which he thinks is important to promote a closer rapport between the public and the police is to give it a local complexion. “I don’t ask for the police to be constituted on ethnic lines,” the CPLC chief stresses. “What I do want is that the policemen in a thana be taken from the same neighbourhood where they have lived for years and have their roots there.” Thus they will not only have an interest in the community tljey are serving. They will also be known to the people who live in that neighbourhood. That will act as a check on their committing any excesses. It will also facilitate the work of law enforcement. The police could be linked up with voluntary citizens’ organisations of the area. This liaison between the police and the neighbourhood would be more effective in maintaining law and order

Buf that is not all. The whole system has to be revamped and the police has to be trained and equipped as a modern force. That would by itself help root out quite a bit of the corruption in its ranks. At present, the lowly-paid policeman is expected to run a thana in which even the stationery is not provided. On nine litres of petrol, the mobile is expected to patrol the thana round the clock. The thanedar is expected to feed his family on Rs 2000 or so a month. In other words, the government will have to spend more money on this sector if the police are to work more honestly and efficiently.

The system is so corrupt and obsolete that it is unbelievable. Jameel Yusuf gives examples. “The police
comes out with names of people who are wanted for innumerable crimes. They are nominated in FIRs
as was the case with the Liaquatabad supermarket killings. But they cannot be identified because the police has no records, though they are all men wanted for earlier crimes. They don’t even have photographs
This inefficiency and corruption extend to other departments of the administration as well and affect
the working of the police. For a paltry sum of Rs 2000, a person can obtain a fake identity card. We
have caught people who had fixed their picture on the ID card of a dead man and got away with it.Many people are released on bail on the basis of forged documents which cannot be verified because a letter from one government department never reaches another. Thus the criminal is back in the world of crime,” Jameel Yusuf says.

But most appalling is the failure of the authorities to acquire the latest technology for storing data, monitoring and scanning records. Such technology is available in Pakistan and the CPLC has demonstrated
its effectiveness. At its central reporting cell, computers are used to keep records of all.the cars registered with the motor vehicle department and of the vehicles snatched. This makes it possible to trace their movement in many cases. That is how at one time the CPLC could recover more than 40 per cent of the cars lost. (The recovery rate has gone down not because of any lapses in monitoring but because of lack ,of cooperation tion from the other provinces where these cars are re-registered and sold.)

With the help of this data, the CPLC can tell you which colour and make is most in demand by the car-lifters (white/red Suzuki), which are the days of the week you are most vulnerable (Thursday)
and the time and locality you are most likely to be a victim (one example, between 8-9 p.m. in the
Delton area of Defence Society). The cell has used computers to draw pictures of suspects and scanners to intercept telephone conversations which has helped them trace kidnappers demanding a ransom. Modern technology and methodology are available to conduct investigations in a civilized and scientific manner without torturing and killing a man. Jameel Yusuf is sorry that they are not being put to use in Pakistan by the police

The CPLC’s mandate is not to replace the police. But in the areas it has been asked to intervene, the CPLC has made a breakthrough. This should be reassuring to a demoralised public. But by its very nature, the agency cannot adopt a high profile. When the people in distress who approach it for help do not want the case to be publicised, Jameel Yusuf says that they have to respect the wishes of the party concerned. If they start producing an annual report of their work, they will be treading on many toes. So they keep quiet about it. They, however, have their accounts audited and they are available for scrutiny. But there is one area in which the CPLC would not like to be he quiet: in creating public awareness about safety measures. “We would like to tell the people how to protect their houses and motor cars. What to do and what not to do to preempt the criminal,” the CPLC chief says. But their resources are limited. They have tried a media campaign in newspapers. The ideal would be crime-watch spots on television but the government has not responded to this suggestion and CPLC does not have the resources to do it on its own as PTV wants it to ay excise duty for such ads. The disarray in the administration and the relative efficiency of the unofficial sector has convinced Jameel Yusuf that the only hope for the country lies in entrusting more and more responsibility to the NGOs. True, not all NGOs are honest and actually functioning. But there are some which are doing good work and making a headway. He is right, for after all the CPLC is an NGO, and its limited resources notwithstanding, it has achieved what the police could not.

But one may add, it is not just the expertise that is necessary. Motivation, dynamism and integrity also count. The CPLC has all three under Jameel Yusuf’s leadership.

Wnen I went to call on Safina Siddiqi on her return from South Africa where she had gone to receive UNEP’s Global 500 Roll of Honour award on the World Environment Day, she was not home. Her house-help who has been with the family for over 20 years duly informed me that she was somewhere in the neighbourhood. I set out to hunt for her, being familiar as I was with her favourite haunts. Within five minutes I had located Safina. There she was at the roadside supervising the planting of saplings. Her hands were full of soil, for she considers her supervision incomplete if she does not show her personal involvement in the work by joining the gardeners in their task.

That did not surprise me. For that is how I have always found Safina — down-to-earth, unassuming with no airs about her and always ready to pitch in when help is needed. No sooner had I asked her how she was, that her eyes lit up and she went on to give me the details of how she had planted sixty-two saplings further down the road before she left for Pretoria. Continue reading Filling a vacuum→

When I went to call on Safina Siddiqi on her return from South Africa where she had gone to receive UNEP’s Global 500 Roll of Honour award on the World Environment Day, she was not home. Her house-help who has been with the family for over 20 years duly informed me that she was somewhere in the neighbourhood. I set out to hunt for her, being familiar as I was with her favourite haunts. Within five minutes I had located Safina. There she was at the roadside supervising the planting of saplings. Her hands were full of soil, for she considers her supervision incomplete if she does not show her personal involvement in the work by joining the gardeners in their task.

That did not surprise me. For that is how I have always found Safina — down-to-earth, unassuming with no airs about her and always ready to pitch in when help is needed. No sooner had I asked her how she was, that her eyes lit up and she went on to give me the details of how she had planted sixty-two saplings further down the road before she left for Pretoria. “Nine of them had died by the time. I returned,” she remarked ruefully. In the next breath she added, “I have now replaced them, so hopefully they will be fine.”

“Tell me something about your trip and the ceremony,” I said trying to get her to talk about herself and not just the plants and her work with which she identifies herself totally. Again her eyes lit up. “It was really thrilling,” she enthused. “You should see South Africa’s parks, they are so beautiful, so huge and so well-kept but with their natural environs intact,” she went on. •

Here was a woman who had received the United Nations Environment Programme’s prestigious award a few days earlier. She was obviously pleased with the honour. But all she wanted to talk about was the planting of trees, repairing of sewers and fixing of roads. To get her to tell me something about the occasion which focused attention on her seemed impossible. With a lot of prodding and questioning I finally managed to get her round to describing it all. She had received the loudest applause. “May be because I was the oldest recipient among the 25 award-winners who were present,” she told me modestly — Safina is nearing 64. Quickly she went on to add that she did not deserve the award singly. “There are so many people who have worked with me and I feel I owe this honour to them. Something more, I can’t describe the thrill and pride I felt when I saw Pakistan’s flag at the venue of the award ceremony,” she said.

It seems that not everyone in Pakistan feels that way. President Nelson Mandela found the time to make a brief scheduled appearance at the gathering to congratulate the award-winners and make an inspiring speech in which he spoke of being a member of the “planetary human family” and the need to preserve the environment. But no one from the Pakistan embassy in Pretoria bothered to turn up. Safina is the second Pakistani (journalist Nafisa Shah being the first) to have won this award which was instituted in 1987 to highlight the work of environment workers. She has emerged as a community leader showing the residents in her neighbourhood the way to operate as a pressure group to obtain from the civic agencies basic facilities like roads, sanitation and drinking water which are the rights of any citizen. In addition, she has also sought to mobilise the residents to work on a self help basis in areas which are not too capital intensive such as tree plantation, maintaining parks, keeping street lights functional and garbage collection. The Karachi Administration Women’s Welfare Society which Safina founded seven years ago has helped transform the area in which it is working. Not that the neighbourhood is an epitome of cleanliness and perfect roads. It is a middle class locality and problems are there in plenty. But without Safina’s driving spirit it would have been immensely worse, as the “before” and “after” pictures which she has methodically fixed in her album testify to.

And yet only 16 years ago, Safina had had limited exposure to the professional world outside. She was a simple housewife running her home for her journalist husband, Zuhair Siddiqi, and the two daughters living with them, the son having taken up a job in America. The sparks of the undaunting courage and initiative which have brought her where she is today were always present in her. Thus not many housewives study at home and appear privately for examinations to get a B.A. degree as Safina did when her own children were in school. She, however, never ventured to take up a job apart from a stint of voluntary social work she did for an institution for the handicapped in Lahore.

And then came the turning point. Her husband was killed in a car accident in Islamabad in 1979 and the sheltered life Safina had been accustomed to came crashing down. Although her son proved to be a great support, she had to find a focus in her life and find something to do to keep herself busy. She turned to what came so naturally to her — her culinary skills. She started conducting cooking classes at home. But after some time she felt her methodology must more scientific. “How could I teach a person to bake a cake or make jam without knowing the nutritional values of the various ingredients. I also had to have an understanding of the scientific principles involved in cooking and preserving food,” she observes. That prompted her to take up courses at the Rangoonwala Community Centre and the Pakistan Hotel Management Institute.

That was Safina. She had to approach whatever she was doing correctly and in proper style. When she moved to her own house in the Karachi Administration Society, there was no time for the cooking classes. Living conditions in the locality were in a terrible state. No paved roads, no garbage collection, no road lights and overflowing sewers. At first she attempted to approach the authorities to get them to set things right. But she soon discovered that a lone voice — and that too a female one — carried no weight in the corridors of power.

It was then that Safina set out to organise a women’s group. Since then there has been no turning back. Initially she worked on the agencies to get the roads built. Then came street lights, trees, a garbage collection system of sorts where none had existed, five parks, the cementing of the storm water drain which had been no more than a kachcha nullah , repairing of sewerage lines and much more.

As had happened with her cooking classes, Safina was not satisfied with simply getting the finished product. She wanted to understand the processes that went into the working of the system. “I felt I had to familiarise myself with the structure and functioning of the different agencies to get the work done. I had to operate within the existing framework or try to change it if possible.” she says.

She adopted a holistic approach. Thus getting the municipality to set up the parks on the plots earmarked for them and planting the trees meant that she had to look into the water supply system as well. Working with women also required her to address problems like the crime situation, insanitation and contamination of water lines in the area. That brought her face to face with issues of membership of housing societies for she soon discovered much to her chagrin that obsolete laws gave the residents and plot-holders who were not original allottees no membership rights and as such no say in the administration of a housing society. In her own way she has become quite an expert on the workings of the civic agencies. She has put her knowledge to practical use by challenging them in cases where she has unearthed illegal allotment of amenity plots and other unlawful activities and even managed to get them revoked. Safina’s ultimate test came in 1992 when she filed a human rights case in the Supreme Court to obtain clean drinking water for the residents of her locality. Armed with photographs and laboratory test reports of water samples she got residents to collect, she convinced the court that the leaking water mains and sewers were contaminating the water supply and thus posed a health hazard. The court ordered the concerned agency to change the pipes “There is much more to be done,” says Safina. “Since the Supreme Court bench dealing with such cases now sits only in Islamabad, it makes it difficult for me to seek legal redress,” she adds.

But she has made legal history for this was the first case of its kind in Pakistan. Similarly her effort to make the Sindh Cooperative Societies’ Act effective so that all plot-owners enjoy membership rights has yet to make a breakthrough.

What sets Safina apart from the innumerable NGOs working in the field of environment? Her goals are the same, namely, to improve the surroundings and thus better the quality of life of the people. For that she also believes that public awareness is essential to enlist the participation and cooperation of the people. This awareness has been created but involvement is lacking. Hence unlike most others she works at the grassroots level, not afraid of soiling her hands. Rather than sitting in airconditioned offices churning out jargon-filled and cliche-ridden reports and programmes, Safina actually goes out in the field and works to set an example for others. You can see her in the company of gardeners and sanitary workers motivating them to complete a task. If something illegal is happening, say an encroachment is taking place, Safina makes her physical presence felt in an attempt to stop it, while she approaches the concerned authorities.

When Safina first got involved in this kind of work she would strive more to bring public pressure to bear against the civic agency to resolve a problem. But gradually she has discovered that this does not always succeed because financial constraints are numerous and administrative hurdles prevent something from being done. Hence she has started mobilising the residents to undertake projects themselves on a self-help basis where possible.

Thus of the five parks she managed to get fenced before encroachments swallowed them up, one has been reserved for women. Safina has concentrated all her energy and resources on its development to demonstrate what can be achieved by the people themselves if they are motivated enough. Spread over 1900 square yards of land which was previously a sewage pond, the women’s park is lush green and well-looked after. The KMC has employed a maali for the park but the supervision and maintenance comes from Safina and her other colleagues. They not only keep an eye on the gardener’s work but take it upon themselves to buy plants and seeds and get the water pump repaired when it goes out of order so that the park does not go dry. Small wonder the park draws crowds of women and children, especially on days the city is in the grip of tension.

She now has a full understanding of where group pressure on the civic agencies is needed, where media exposure is necessary and where legal action is called for. “My immediate goal is to revive public interest litigation to help citizens obtain their civic rights. After all potable water, sanitation, public parks and clean air are the basic rights of the people. I hope to win these rights through the courts.

“But I must stress that we need public involvement as well. Environment awareness is not enough by itself. It must be followed by action, which unfortunately is not forthcoming in most cases. Public participation can come through mohalla committees which people in every neighbourhood of Karachi should set up. These committees should have in their folds public spirited men and women who are willing to work to obtain clean water, sanitation, tree plantation and security. We are willing to share our experience with them,” Safina says.

She also hopes to develop the four parks in her Society which are at present no more than vacant plots with a fence round them. Additionally she is trying to devise a door to-door garbage collection system in her Society in the near future with the cooperation of the residents. “I am confident that this can be done especially now that sufficient awareness has been created and people themselves want it. They approach me for advice and help and are also willing to pay for some of the services,” she says.

To mobilise and lead women for their own uplift comes very naturally to Safina. She went for a year to Murree to get her house built on the land that she had inherited from her father. Within no time she had mobilised the women in the neighbouring village to set up a vocational centre, obtain clean water and open a dispensary.

And yet Safina is working against heavy odds. She realises it. “The major problem is that the community feeling which was such a source of strength to the people in yesteryear has broken down all over the country. Pakistanis have become more individualistic and more selfish in the process. They do not want to share anything — be it their wealth, their knowledge, their time, or their effort. Money and upward mobility has destroyed their collective spirit,” Safina observes sadly.

“Not that they are not concerned at the garbage littered around or the shortage of potable water. They are quite articulate about their concerns. But most of them are not at all prepared to take collective action by getting involved in common corrective measures. Thus they do not want to join hands to demand water. Instead they will go and buy bowsers for themselves. If there is crime in their locality, they do not opt for a neighbourhood security system. They will hire an armed guard. If their own garden is clean they will not do anything to get the garbage dump outside their home cleared. Of course there are some people who are an exception and I derive a lot of support from them, but their number is not substantial enough to make a wide impact,” she adds.

“You will be surprised that the worst are the so-called educated people, especially the professionals, who can and should be doing the most. But no lawyer from our neighbourhood offered us his services when we went to court although we have so many lawyers living in this locality. None of the doctors who lives here has taken any interest in the sanitation work we are involved in. Even the religious leaders do not want to take up the cause of the environment. They never talk about issues such as planting trees or keeping one’s neighbourhood clean in their khutbas and dars. Probably they consider such matters as too mundane. But when we planted trees around the mosque the pesh imam was delighted — could he not have undertaken this job himself with the help of his congregation?” Safina asks. The public approach and behaviour very often leave her in despair.Source: Dawn

A few months ago, there was no light at the end of the tunnel for Anwar Jamal. Today, he and his wife Fatima are at peace with themselves and grateful for that.

As the parents of triplets, two of whom were born joined at the head, for two years the Jamals had to live with this aberration. Their life was being affected and they could not figure out a solution to their problem.

When I met them in their apartment in the MacDonald House close to the Hospital for Sick Children (HJSC) in Toronto in April, they had lost one of the conjoined twins, Nida, six weeks ago. But there were hopes for Hira, the surviving sister, who had lived for 27 months joined to Nida until they were separated after a 17-hour operation on January 23. Continue reading Will Hira be able to cope when she gets back?→

TORONTO, April 6: The 30- month-old surviving conjoined twin, Hira Jamal, who was separated from her sister, Nida, in January at the Hospital for Sick Children after a 17-hour operation, is doing well and will shortly be returning home to Karachi.

On Wednesday, Hira underwent a reconstructive surgery on her scalp. If the post-operation healing is normal, as Dr Harold Hoffman, the neurosurgeon under whose care Hira has been, hopes it will be, the infant should be released from the hospital in a few weeks.

Hira’s Siamese twin sister was Nida, from whom she had been inseparable for over two years until Dr Hoffman performed a surgical feat to separate them. Nida died a month after the operation. The two girls along with a third, Faryal, were born to Fatema Jamal in October 1992 in a Nazimabad clinic. Faryal was normal, while the other two were joined at the head — a rare condition said to occur in one in two million births.

Hira and Nida spent the first two years of their lives at the National Institute of Child Health in Karachi. The turning point came when Dawn carried a report on them and Prime Minister Benazir Bhutto announced that the government would help bear the cost of the twins’ surgery abroad. Since then the Hira-Nida story has been a remarkable tale of human compassion, professional devotion and skill and fund-raising which has transcended international boundaries. Talking to Dawn, Dr Hoffman was full of praise for his team which participated in the operation that has given Hira the chance to lead a normal life. A price had to be paid and Nida died. Dr Hoffman said: “The case was more complicated than we had initially believed. Nida’s kidneys were not functioning and we had to transplant one of Hjra’s organs in Nida. Hira’s heart was under strain since it was pumping blood into her twin sister’s circulatory system. If we had not operated, both would have died. In spite of the risk factors, I had been hopeful for both.”

About 10 surgeons and specialists have been involved in this case — one of the 30 recorded in medical history when an attempt has been made to separate Siamese twins joined at the head. They have waived their fees. The Pakistani community in Toronto has so far raised 260,000 dollars to help meet the hospital costs and the board and lodging expenses of the twins’ parents and the third sister who accompanied them to Canada. The Pakistan government’s contribution has been to the tune of 135,000 dollars. PIA provided free tickets.

Dr Hoffman is confident that Hira will grow up to be a normal child. At present she is undergoing ‘therapy to help her sit, stand and walk, which she could not do before, because of her handicap. Initially after the operation, she missed her twin sister, Nida, but has forgotten her now. Without the medical / surgical skills, nursing and therapy offered by Toronto’s Hospital for Sick Children, Hira’s chances of survival would have been nil. The Pakistani community pitched in with fund raising and social support to help the Jamal family tide over the crisis.

Afew months ago, there was no light at the end of the tunnel for Anwar Jamal. Today, he and his wife Fatima are at peace with themselves and grateful for that. As the parents of triplets, two of whom were born joined at the head, for two years the Jamals had to live with this aberration. Their life was being affected and they could not figure out a solution to their problem.

When I met them in their apartment in the MacDonald House close to the Hospital for Sick Children (H.SC) in Toronto in April, they had lost one of the conjoined twins, Nida, six weeks ago. But there were hopes for Hira, the surviving sister, who had lived for 27 months joined to Nida until they were separated after a 17-hour operation on January 23. Little did I realise that the twins from Pakistan had made media headlines in Canada. A visit to the world-famous hospital which had accepted them with open arms and an update from Dr. Harold Hoffman, the neurosurgeon under whose care they had been, gave me a better perspective of the case.

Here was a human interest story, but it was not one of sensationalism and drama of which the western media is equally capable. The twins’ story was one of human compassion and spirited fund-raising by men, women and children 10,000 miles away from home. More importantly, it was a story of professional commitment and achievement by members of the world of science and medicine in which the western societies take so much pride.

As Fatima dressed up little Faryal, the third sister who was born with Hira and Nida, and Anwar made tea for us, the couple recounted to me the family’s tribulations and moments of hope and despair since October 1992 when the triplets were born in a Nazimabad clinic in Karachi. Hira and Nida were what in medical terminology is called craniopagus conjoined twins. The father rushed them to the National Institute of Child Health (NICH) where they were not expected to live for more than a day or two. But they defied all prognosis and survived the trauma of their birth and congenital abnormality. Thus began a story of a father’s devotion and struggle to give his daughters a decent life. He resisted suggestions from well wishers to let the infants starve to death. For two years, he visited the hospital everyday to see the girls, deliver milk and baby food for them, launder their clothes and provide all their basic heeds. The NICH, like all other health facilities in the public sector in Pakistan, lacked the resources to care for the twins on a long-term basis. But the Jamals knew they could not take the twins home in their unnatural state. “We could never have looked after them. Our house does not even have a concrete roof. They could never have survived had we taken them home where I already had three children to care for,” Fatima said.

The nurses at the NICH doted on the twins, played with them, cherished them and taught them songs and nursery rhymes. But the hospital lacked the facility and the expertise to separate them. Even an MRI entailed repeated visits to the Liaquat National Hospital in a taxi, by no means a painless journey for the infants. In the process, Anwar Jamal chalked up a debt of Rs 80,000, which he still has to repay.

The story was first reported by Dawn and Prime Minister Benazir Bhutto responded by directing the government to pay for the twins’ treatment abroad. (It ultimately paid 135,541 Canadian dollars, to be accurate, though not without the traditional tardiness of our bureaucracy and the Foreign Office’s intriguing silence to repeated queries from its consulate in Toronto). Next came the Hospital for Sick Children’s positive and prompt response to the request from NICH if the twins could be treated there. (The doctors waived their fees). Finally, there was a massive display of humanitarian spirit by the South Asian community in Toronto, which welcomed the Jamal family in its midst and stood by it in its hour of crisis. PIA provided free tickets for the twins and their parents (but not the accompanying triplet — by some strange logic). “When I boarded the plane in Karachi on November 5,” Anwar Jamal recalled, “I just had Rs 500 in my pocket and had no inkling where I was headed for. Since that is how things work in Pakistan, I took the plunge as I was so desperate.” In Toronto, the family was received at the airport by Dr Shahida Khan, a Pakistani-Canadian paediatrician at the Hospital for Sick Children, who played a key role in helping the Jamals to find their bearings in a strange new

It was a joint effort by a committed medical community and devoted parents that saved Hira’s life. But the crucial question remains: will Pakistani hospitals be able to provide Hira with all the medical support she needs to fully recover and lead a normal life?

world of which they knew nothing. She provided them some money for their initial expense, arranged their immediate transfer to the hospital from the airport, mobilized the fund-raising and acted as the interpreter to facilitate communication between Anwar Jamal and the health professionals looking after the twins. Anwar is now fluent in English.

The response of the South Asian Muslim community in Canada was heart-warming, not just in monetary terms. It readily identified itself with the Jamal family whose concern for the twins’ welfare became its own concern. The day the surgery took place, hundreds of people joined the Tamals in a vigil, praying for the success of the operation. When Nida died a month later, the community turned out in large numbers to console the grieving parents and bury the infant. They raised 263,000 dollars for meeting the cost of the twins’ hospital care and more is still coming in.

For the Hospital of Sick Children, the Hira-Nida case provided a rare opportunity for its surgeons and doctors to apply their professional skill and open new vistas for research. The hospital, which has a reputation for extending its services to young patients with serious illnesses from abroad, had separated three sets of conjoined twins before. But as Dr Hoffman said, none had been joined at the head, He accepted the challenge, the heavy odds against success, notwithstanding. In the last hundred years for which records are available, only 35 craniopagus conjoined twins separations have been attempted. Both twins have survived in one third, but one of them with some neurological problems. And one twin survived in the rest.

“Had we not attempted the separation, both babies would have died shortly. We had to advance the date of the operation, because Hira’s heart had started to give way. Moreover, I was hopeful of saving both the children,” Dr Hoffman told me. “It was only after the twins arrived at the hospital and the joined twin sister Nida. That was the price the Jamals had to pay so that Hira could live. A bigger challenge lies ahead for them when they return home to their older two children in a few weeks. The cultural shock will be intense, for the transition from the comfort of McDonald House to the investigations had been made that we discovered that there were more complications than we had expected. Nida’s kidneys were not functioning at all and her sister’s organs were under tremendous strain as they were producing urine for both. Hira’s heart was also enlarged as it was pumping blood for both the children. The positive finding was that the twins essentially had two separate brains but their dura maters had a small bridge between-them. The blood vessels travelling from one sister to the other posed a challenge, as they had to be disconnected carefully,” Dr Hoffman informed me.

DR. HOFFMAN The neurosurgeon

Describing the case as a rare anomaly that occurs in only one in two million births, Dr. Hoffman commended the team effort, which made the separation procedure possible. Urologists, neurosurgeons, cardiologists, radiologists and plastic surgeons — nearly 12 of them — were involved. A month before the separation surgery, one of Hira’s kidneys was transplanted in Nida. The saggital sinus which the twins shared and the artery from Hira to Nida were disconnected to minimise the blood loss during the surgery. Tissue expanders were implanted in their scalps to promote the growth of skin to cover the wound caused by the surgery. The operation was a success and enabled the twins to have a separate existence for the first time in 27 months. The risk of their dying on the operation table of massive blood loss had been great. But Nida, the weaker of the two, could not make it and died a month later of cardiac arrest. Hira has recovered well. Initially she would feel above her head as she searched for her twin sister. Now she has adjusted to her separate identity. Her post-operative care has focused not just on healing her wounds caused by the operation. Plastic surgery is taking care of that. She has been receiving nutrition through a tube in her nose round the clock to help her gain strength and weight. She has received intensive therapy to help her learn to do things which come naturally to toddlers of her age — sitting, standing, walking, eating, drinking. Above all, she had to be Dr Hoffman informed me.

Describing the case as a rare anomaly that occurs in only one in two million births, Dr. Hoffman commended the team effort, which made the separation procedure possible. Urologists, neurosurgeons, cardiologists, radiologists and plastic surgeons — nearly 12 of them — were involved. A month before the separation surgery, one of Hira’s kidneys was transplanted in Nida. The saggital sinus which the twins shared and the artery from Hira to Nida were disconnected to minimise the blood loss during the surgery. Tissue expanders were implanted in their scalps to promote the growth of skin to cover the wound caused by the surgery. The operation was a success and enabled the twins to have a separate existence for the first time in 27 months. The risk of their dying on the operation table of massive blood loss had been great. But Nida, the weaker of the two, could not make it and died a month later of cardiac arrest. Hira has recovered well. Initially she would feel above her head as she searched for her twin sister. Now she has adjusted to her separate identity. Her post-operative care has focused not just on healing her wounds caused by the operation. Plastic surgery is taking care of that. She has been receiving nutrition through a tube in her no round the clock to help her gain strength and weight. She has received intensive therapy to help her learn to do things which come naturally to toddlers of her age — sitting, standing, walking, eating, drinking. Above all she had to be separated from her conjoined twin sister Nida. That was the price the Jamals had to pay so that Hira could live.

A bigger challenge lies ahead for them when they return home to their older two children in a few weeks. The cultural shock will be intense, for the transition from the comfort of McDonald House to the difficult living conditions of New Karachi will not be easy. To ease the process, Hira who was released from the hospital on April 26 was not sent home right away. She is living with her family in an apartment in Toronto, where they have been instructed to treat her as naturally and normally as they can. For instance, she is to eat Pakistani meals so that doctors can monitor her adjustment to what life will be like in Karachi when she returns here.

The Jamals will also miss the community support they received away from home. This is not always forthcoming in a society which is impoverished, strife-torn and struggling to keep itself together. But most important of all, will Hira’s entry into the world of normal living be uneventful? She would need medical supervision and monitoring for some time.

From Toronto’s Hospital for Sick Children where she had become the darling of all and sundry she will arrive in Karachi — it is still not known under whose care. One hopes that the medical community in Pakistan will rise to the challenge so that Anwar Jamal’s ‘jewel’ can lead a normal life and Canada’s medical fraternity does not feel let down.

One of the most crucial issues which has had a profound impact on Pakistan’s economy, politics and sociocultural development is the high population growth rate. With its population having more than quadrupled from 32 million to 128 million in 47 years, the country can ill-afford to neglect the demographic sector. Seen against this backdrop, any attempt to analyse elucidate the family planning programme in Pakistan is a welcome endeavour. Dr Nadir Ali Agha, the author of the book under review, presumably prepared this manuscript as his dissertation for his master’s course in health management from the University of Birmingham. He has managed to compress a lot of information about Pakistan’s population programme in this little book.

In a nutshell the reader is provided the relevant and important demographic data, a history of the official strategy (from the target oriented approach of the sixties to the continuous motivation system and the contraceptive inundation policy of the seventies and the mutli-sectoral approach of the eighties) and an analysis of the factors which have proved to be obstacles in the successful implementation of the programme (illiteracy, lack of motivation, improper contraceptive use and counselling, inefficient programme structure and inadequate financial resources).

Dr Agha’s efforts notwithstanding, it is plain that he has no practical experience of working in the field in the population sector. The knowledge he has acquired through books and documents (obviously official publications) is of a theoretical nature and divorced from reality. Thus it is strange that the author has found no link at all between the population problem and the status of women in Pakistan. It is now widely recognized that a major factor for women having a large number of children is their lack of empowerment. In any society where women lack esteem and are excluded from the decision-making process, be it at the family level or in the national structure, they tend to have many children.

Male offspring provide them the social and economic security which they otherwise lack. This fact is not disputed and if Dr Agha had followed the proceedings of the Cairo conference on population and development closely he would have detected this link. The author’s inadequate grasp of the sociological dimension of the family planning programme in Pakistan would explain why his recommendations are so of the mark. He focusses on the information and education component of the programme giving suggestions as to how birth control should be popularised. But surveys indicate that most couples already know about the importance of small families and many of them (28 per cent) want to restrict the size of their families but have no means available to them to do so. There are others who opt for many children to ensure that they have a number of surviving sons. Yet others are under social and family pressure to have big families. A population programme which does not take into account the gender factor cannot hope to succeed. Dr Agha should also take note of it.

Finally, one can add that a good editor would have given the book the professional treatment which goes into the making of a well-produced book. Why our writers are neglecting this aspect of publishing is difficult to understand.

How much do we love our children? The conventional wisdom holds that oriental societies show greater affection and concern for their young ones than the industrialised nations of the west where parents are too involved in the rat race. This might be true in the individual family context, but at the wider social and institutional level not all Third World countries have a uniform track record in their treatment of children.

Without going into the usual homilies of children need to be looked after because they are the wealth of the nation and the citizens of tomorrow, one can state without fear of contradiction that the approach a society adopts vis-a-vis its children is a measure of its social/political maturity. It is also indicative of the level of civilisation it has achieved. Contrary to popular belief, the status of the child in a country is not determined by its economic resources or the degree of its development UNICEF’s latest report The State of the World’s Children 1995 more than proves this point.

Using the U-5MR (under-five mortality rate) as the criterion to rank countries, UNICEF makes it possible to compare the performance of societies. The painful fact which emerges very clearly is that Pakistan with a higher per capita in’-ime than many others has done worse than them in looking after its children. What is most disconcerting is that the political and social commitment and the concomitant effort which are so essential to make progress in upgrading the quality of life of the child are totally missing in our case.

Countries like Nepal and Bangladesh which ranked below Pakistan five years ago have pulled themselves up and are way ahead of us today. In 1990 we ranked 33rd in ascending order, that is 32 countries had a higher child mortality rate than Pakistan. Bangladesh stood 22nd and Nepal was 18th. The latest report shows Bangladesh and Nepal as ranking 39th and 38th respectively. Pakistan continues to be 33rd India has also shown some progress.Its ranking went up from 37th in 1990 to 40th in 1995. In 1993, the child
mortality rate of the four states n a m e l y B a n g l a d e s h Nepal, India and Pakistan was 122,128, 122 and 137 per 1000 live births respectively And yet, of these countries Pakistan has the most impressive economic indicators.Its per capita GNP in 1992 was 420 dollars, when the corresponding figures for B a n g l a d e s h , Nepal and India were only 220, 170 and 310 respsctwety.

The percentage of the population living below the absolute poverty line was higher (much higher in
the case of Bangladesh) in these three countries as compared with Pakistan Nevertheless, their financial constraints notwithstanding the first three performed better in childcare

How would one explain this phenomenon? As the UNICEF report states, U-5MR is determined by a wide variety of inputs such as health and nutrition of mothers, immunisation and ORT use level, safe water supply, sanitation, and the availability of health care. In other words the level of social development
of a people manifests itself in the form of the child mortality rate because children are the most vulnerable segment of a population and the impact on them of any negligence is the greatest Woefully, it is this aspect of life which is the most neglected in Pakistan. •

But another factor which has a powerful impact on children and which the UNICEF report notes not sufficiently emphatically is the degree of empowerment of women, to use the Cairo summit’s
phrase. It is only when women have been empowered to decide when to become pregnant (through greater
equality in decision-making and higher quality family planning services) that, the fertility rate- falls. This has a direct impact on child mortality since the mothers are better equipped to take care of their children. Of course conversely,lower child mortality gives parents the confidence to have fewer children.

It is hardly a coincidence that Pakistan has the highest population growth rate and crude birth rate and the lowest contraceptive prevalence rate as compared with Bangladesh, Nepal and India. The following statistics are most revealing If we want to save our children, we will have to save our women. It is plain that our society’s reluctance to raise the status of women — in plain words, to empower them — that is pulling us down the ladder of social development. It is time this issue was addressed in real earnest before the fabric of our society disintegrates altogether